Retrograde Intrarenal Surgery in Children with Kidney Stones: Single Surgeon Experience

ÇOCUK HASTALARDA RETROGRAD İNTRARENAL CERRAHİ

Abstract

Introduction:  In the recent years, there has been a significant rise in paediatric stone disease population, hence with the advancement of technology, new minimally invasive treatment methods have been developed like percutaneous nephrolithotomy, retrograde intrarenal surgery (RIRS), shock-wave lithotripsy (SWL) and laparoscopic stone surgeries.

Objective: In this study, we aimed to evaluate the data of paediatric RIRS cases performed by single surgeon in our clinic and to affirm the effectiveness and reliability of this method in treatment of kidney stones in children.

Patients and Method: The data of 29 patients (13 boys and 16 girls) under 18 years of age who underwent RIRS due to kidney stones between April 2012 and September 2019 were analyzed retrospectively. All the operations were performed by the same surgeon. Urinary system x-ray, ultrasonography (USG) and non-contrast computed tomography (CT) scans were used to determine the urinary tract anatomy and stone characteristics.

Results: The median age of 29 children was 8 (1-17) years. The mean stone diameter was determined as 11.4 ±0.875mm, 17(58.6%) patients had solitary stones and 12(41.4%) patients had multiple stones. In 7(24.1%) patients stones were situated in the renal pelvis, while 14(48.3%) were in lower calices and 8(%27.6) were in middle/upper calices. Ureteral access sheath was inserted in 11(38%) patients during the procedure, but not in the remaining 18(62%). The mean fluoroscopy time was 12±0.735sec. Double-J (DJ) stent was placed in all patients at the end of the procedure. The mean length of hospital stay was 1.2 days. The stone-free rate was 72.4% at the end of single session, 2(6.9%) patients received a second-look RIRS, and SWL was performed in 1(3.4%) patient postoperatively. Stone-free status was achieved in both patients after the second RIRS thus the final overall stone-free rate for RIRS was 79.3%.  Postoperative febrile urinary tract infection developed in 1(3.4%) patient.

Conclusion: RIRS is a minimally invasive treatment method in kidney stones that can be performed safely with high success rates in the paediatric age group within the appropriate indication.